Guyana Nurse Training Program: A big 'Ol pile of shift work....

As anyone who has worked a "shift" job, things are much different the later the hour gets. Less administration, auxiliary professionals and visitors help create a mellow vibe that allows for more concentration on your tasks at hand while maintaining more independence and autonomy in your practice. While some people may think that only the strange/crazy vampirish people sign up for nights, there are actually advice columns stating that nights are better for shy, introverted intellectuals who need the mellow atmosphere in order to function at their best. Regardless of our reasons for working nights, we know that we are often short staffed and without interdisciplinary resources, making us rely on our own abilities and unit collaboration in order to get things done.

I wanted to investigate the workings of a night shift in our NICU, so I worked from 8:30pm until about 1am on Saturday night while Randy went to pick up our next team member, Priscilla. When I arrived, only 1 out of the 6 RNs who were scheduled were there. Another 2 were present by 9pm, which still left them short 3 nurses. The unit was a ghost town. With 4 rooms of babies and only 3 nurses, there were babies always left alone. Mothers spent less time, only coming to express milk or breastfeed and then return to their beds on the post-natal ward for some much needed rest. In the 5.5 hours I was there, I never once saw a physician. I've been told there is only 1 doctor on nights, who often has to cover the pediatric ward, post-natal ward and NICU along with getting rest, as they usually have been there all day. No wonder the docs have a sign on their door saying "No knocking"- they don't want to be disturbed all night (however, it doesn't do much to inspire nurses to take action when they have a question or concern). On top of all of this, each nurse is entitled to a 3 hour rest period, which usually leaves 1 RN in charge of the entire NICU at times. Additionally, there is usually no one available to take X-rays and the physicians are too tired and busy to get lab draws or place IVs, often leaving babies without needed treatment until 7am. No wonder alarms get ignored, babies get cold, respiratory distress increases, and babies have poor outcomes. We only had 12 babies (they usually have 20-30) and the three nurses were barely keeping up, even with me being their "PCA"- I told them to delegate tasks to me, which meant I took vitals and fed babies (fine by me!).

While I may not be able to fix all the problems of night shift, it's clear that one of the main issues is RNs not being penalized for missing work. When only half of your scheduled staff actually show up, that's a major problem. If I could only get a meeting with nursing administration....third week's the charm!

Sunday brought some much needed relaxation (my brain is so full and tired from the week) at the Marriott (my new Georgetown happy place) with Randy and Priscilla before gearing up for another busy week!